Meningitis is the inflammation of the spinal cord and brain’s protective covering, called as the meninges. The causes of infection are bacteria, viruses and microorganisms and also rarely by certain drugs. Meningitis is considered as a medical emergency because of the brain and spinal cord involvement.
The common symptoms include stiff neck and headache associated with confusion, fever, vomiting, photobia or light intolerance or phonophobia or loud noises. Symptoms such as irritability and drowsiness are some of the nonspecific symptoms of meningitis usually present in children. A rash may signify a certain cause of meningitis, like meningitis with meningococcal bacteria as a causative agent.
To diagnose meningitis, a lumbar puncture is done. Lumbar puncture is initiated through insertion of a needle in the spinal canal to get a cerebrospinal fluid sample (CSF), a fluid that coats the spinal cord and brain. The CSF is then brought to the laboratory to be examined. Antibiotics and sometimes antiviral drugs are the treatment for meningitis. Corticosteroids are also used for some situations to prevent complications from inflammation. Meningitis may lead to long-term conditions such as epilepsy, deafness, cognitive deficits, and hydrocephalus if not treated immediately.
Haemophilus influenza type B, meningococci, mumps virus and pneumococci which are associated with meningitis can be prevented through immunizations.
The bacteria that cause meningitis vary depending on the age group. In newborns and premature babies, the common bacterial causative agents are group B streptococci which normally live in the vagina and E. coli that lives in the digestive tract. Newborns are also infected by Listeria monocytogenes. Older children are infected with Neisseria meningitidis, streptococcus pneumonia and children under 5 years by Haemophilus influenza type B.
In adults, streptococcus pneumonia and Neisseria meningitidis causes the 80% of all bacterial meningitis including Listeria monocytogenes in 50 years old people.
The incidence of pneumococcal meningitis in newborns and adults declined since the pneumococcal vaccine was introduced.
Aseptic meningitis means that the causative agent involved is not bacteria. The cause is usually a virus or with the participation of bacteria that has been treated and disappeared before and disappears from the meninges. An example is endocarditis, an infection of the valves of the heart with small particles of bacteria in the blood stream causes aseptic infection.
Viruses causing meningitis are herpes simplex type 2, enteroviruses, varicella zoster virus, HIV, and mumps virus.
If eosinophils are found in the CSF, it is assumed as parasitic cause. Gnathostoma spinigerum and Angiostrongylus cantonensis are the common viruses causing meningitis.
The initial treatment for meningitis is wide-spectrum antibiotics. If the patient is hypotensive, intravenous fluids should be given. If necessary, transfer to intensive care unit for thorough observation and quick response by health care providers is a must. If the consciousness level is low, mechanical ventilation should be connected to support the breathing.
After culture is done and the kind of bacteria is known, the antibiotic most sensitive to the particular bacteria will be administered to the patient. Cefalosporins are found to be increasingly resistant to streptococcus strains. Vancomycin is usually added to treat meningitis. Steroids like corticosteroids such as dexamethasone are also used for treating meningitis.